Date: Mon 8 Aug 2016
From: Dr Seif Al-Abri, <firstname.lastname@example.org>, Dr Idris al-Abaidani and Dr Ali Al-Moqbali [edited]
Brucellosis is one of the major zoonotic infectious diseases in Oman; it was mainly restricted to the southern part of the country in the Governorate of Dhofar. The region receives rainfall during June to August (Kharif season). Animal herding including cattle, camels, sheep and goats is the main profession of the people living in the mountains of Dhofar. A serosurvey conducted in 1985-86 in the animals in Dhofar Governorate revealed a prevalence of brucellosis of 8 per cent in camels, 6.4 per cent in goats and sheep and 3.3 per cent in cattle. The northern Governorates in Oman have shown a consistently low incidence for brucellosis in the past decades.
However, recently there has been a rise in the number of cases. A cluster of 55 brucellosis cases was identified during the period May to July 2016 from the coastal area in the north of Oman mainly in the North Batinah Governorate. The index case was confirmed by positive serology for _Brucella melitensis_ and a positive blood culture on 15 May 2016. Epidemiological investigation revealed 6 additional cases in the family. There was no history of visiting or staying in southern endemic area of Dhofar. There was a history of consumption of locally produced goat cheese. The local cheese producer had over 100 goats and a cow in his farm; it was his traditional family business.
Additional cases and family clusters were diagnosed during the period of intensive surveillance (15 May -- 31 Jul 2016). Several had a past history of consuming the locally produced goat cheese. The Ministry of Agriculture conducted a serosurvey among the farm animals of the cheese producer and the 23 seropositive goats were culled. Further investigations are ongoing and long term actions will be decided on the information in collaboration with the Ministry of Agriculture and the Municipality. A joint plan of action has been drafted to deal with the surge of the disease in the northern governorates of Oman with the aim of eradicating the diseases from animals in this part of the country.
As of 31 Jul 2016, 236 cases of brucellosis were reported to the Surveillance department at MoH, of which 71 (30 per cent) were from northern governorates. This proportion is over 3 times of the average of 2010 to 2015 (8.1 per cent). --
Dr Seif Al-Abri Dr Idris al-Abaidani Dr Ali Al-Moqbali Salem al-Mahrooqi Ministry of Health Muscat Sultanate of Oman email@example.com
[ProMED-mail thanks the authors for submitting this report. Brucellosis is zoonotic infection that can be spread not only by direct contact with the animal carrier but also by the ingestion of unpasteurized dairy products such as milk and cheese. The infection is also known as undulant fever, related to the occurrence of 1-3 week febrile periods separated by 1-3 days of afebrility. This occurs more likely with _Brucella melitensis_ (acquired from goats) than with _B. abortus_ (cattle) and _B. suis_ (swine). The infection can be subclinical. Acute symptomatic brucellosis is generally manifest with nonspecific symptoms such as fever, chills, night sweats, anorexia, and an increased sense of ill health.
The disease can be diagnosed serologically and/or by blood culture. The organism may grow quite slowly on primary isolation, and the clinician should make the microbiology laboratory aware of this potential diagnosis. Localized infection may occur. Sites for localization include the skeletal system (1), heart valves (2) and urinary tract (3). Genitourinary [GU] brucellosis may present identically to GU tuberculosis. Psychiatric manifestations such as depression and anxiety are possible as late symptoms of brucellosis (4, 5), so-called chronic neurobrucellosis. It remains unclear whether active brucella infection is present at that time. Overt central nervous system infection can, however, include meningitis and encephalitis (6,7).
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2. Beeching NJ, Corbel MJ. Brucellosis: Chapter 194e in Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al [eds.]. Harrison's principles of internal medicine, 19th edition. McGraw-Hill, 2015; 194e1-5.
3. Leder K, Torresi J, Libman MD, et al. GeoSentinel Surveillance Network. GeoSentinel surveillance of illness in returned travellers, 2007-2011. Ann Intern Med. 2013; 158(6): 456-68; available at <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629801/
4. Pappas G, Papadimitriou P, Akritidis N, et al/ The new global map of human brucellosis. Lancet Infect Dis. 2006; 6(2): 91-9; abstract available at <http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(06)70382-6/abstract
5. Pappas G/ The changing _Brucella_ ecology: novel reservoirs, new threats. Int J Antimicrob Agents. 2010; 36 Suppl 1: S8-11; available at <http://www.ijaaonline.com/article/S0924-8579(10)00254-2/pdf
6. Dean AS, Crump L, Greter H, et al. Global burden of human brucellosis: a systematic review of disease frequency. PLoS Negl Trop Dis. 2012; 6(10): e1865; available at <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3493380/
7. Garin-Bastuji B, JaÃ¿ M, Mick V. Review and update on brucellosis in Asia and Pacific Region. Presentation at the 4th FAO-APHCA/OIE/DLD Regional Workshop on Brucellosis Diagnosis and Control in Asia and Pacific Region -- Proficiency Test and Ways Forward for the Region. Chiang Mai, Thailand, 19â€21 March, 2014; available at ,<http://www.rr-asia.oie.int/fileadmin/Regional_Representation/Programme/Emerg/2014_Brucellosis_Chiang_Mai/Dr_Bruno_Garin-Bastuji.pdf
8. Wongphruksasoong V, Santayakorn S, Sitthi W, et al/ An outbreak of Brucella melitensis among goat farmers in Thailand, December 2009. OSIR. 2012; 5(1): 14-21; available at <http://www.osirjournal.net/issue.php?id=30
9. Ekpanyaskul C, Santiwattanakul S, Tantisiriwat W, Buppanharun W. Factors associated with seropositive antibodies to Brucella melitensis in the Nakhon Nayok, Thailand. J Med Assoc Thai. 2012; 95 Suppl 12: S40-6; available at <http://www.pubfacts.com/detail/23513464/Factors-associated-with-seropositive-antibodies-to-Brucella-melitensis-in-the-Nakhon-Nayok-Thailand
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